Why working mothers hardly breastfeed

In January 2010, Harriet Kemirembe welcomed her first baby. Before she went for maternity leave, her human resource manager told her the company would only give her one month to nurse her baby, after which she was expected to return to work.

After a month had elapsed, she felt her baby still needed more care and went to her workplace, a radio station in western Uganda, to renegotiate terms and service.

Her pleas, however, fell on deaf ears and she had only two options; either to work or to quit. After a day of reflecting, especially on her workload and her pay cheque at the end of the month, Kemirembe made a painful decision to hand in her resignation.

Loss of jobs
“I needed to earn but I chose to prioritise my baby. I was guilt-ridden to leave a month old baby at home in the name of making money,” she says.

When her baby made two years, she embarked on job searching and five months later, she was got an appointment letter.

While some women are given three months of maternity leave in some organisations, others are told to leave their jobs the moments they are due for delivery. Even those that report to work after the maternity leave lose breastmilk a few months later because they have to cope with a busy working environment.

But is exclusive breastfeeding still feasible in a world where women are expected to be financially independent?

Despite several attempts, Rita Nakirya failed to produce enough milk for her new born baby.

“I had been told that because I had delivered by c-section, it would take a few days before breast milk production started. Even with warm fluids I was advised to drink, all I could produce was 25ml of milk which was insufficient for my baby,” she says.

Latching
Nakirye’s baby also failed to latch, which made sucking quite challenging. Latching is how babies getthe breast into their mouths and it enables them to suck. If the baby has not latched the breast well, they cannot ably suck.

Her baby later lost interest in breastfeeding and her nipples started to hurt. She later resorted to pumping milk.

Dr Doreen Mazakpwe Ssemujju, a lactation specialist, says milk production is only possible when what is in the breast is removed to make room for more and poor latching affects demand as well as supply.

Causes of poor latching
Dr Mazakpwe says when this happens, seeing a lactation specialist helps to diagnose the issue. “Some of the reasons for poor position maybe that the mother has had an operation, is in some form of pain, or is simply ignorant about how to hold the baby when breastfeeding it,” she says.

Other causes of poor latching on the mother’s side include, flat nipples, inverted nipples, and nipples bigger that what the baby’s mouth can take in.

Poor latching, apart from poor positioning on the baby’s side, according to Dr Mazakpwe could be due to structural issues such as down syndrome hence low muscle tone and because the tongue is a muscle, it will also be weak and ineffective.

“Another structural problem could be those in the baby’s mouth hence the baby suffering a tongue tie. While most mothers check out for the skin just below the tongue, sometimes, it is hidden.

If the baby suffered some tremor at birth such as prolonged labour, coming out fast, if they were too big hence struggled to go through the birth canal, if they were pulled excessively when being delivered, or if instruments were used at delivery, Dr Mazakpwe says these can cause the muscles of the jaws to get strained or gum down on the breast hence poor latching.

Baby never gets satisfied
She points out that a poorly latched baby will never get satisfied because they will get filled with air rather than milk, which leads to low weight gain.”

On the mother’s side, poor latching will lead to breast pains such as sores on the nipples, mastitis, breast abses, milk blebs, and engorgement.

Signs of poor latching include any pain while feeding, pain or discomfort in one of the breasts.
“However, this pain is different from the sensitivity one will feel in the first two to three days of starting to breast feed. Back pain, in the case of the mother, shows baby poor position while feeding. Besides that, a mother who has a history of difficult labour should see a lactation specialist if they were not part of the delivery team,” Dr Mazakpwe advises.

With latching and positioning solved, she says a mother will be able to feed their baby well.

Risks invloved
The World Health Organisation (WHO) recommends exclusive breastfeeding in the first six months and at least two years of breastfeeding for all infants.

Despite this recommendation, in Uganda, breastfeeding durations still fall short, with only 66 per cent of children under six months exclusively breastfed, according to the 2016 Uganda Demographic and Health Survey.

Dr Boniface Otto Ssegujja, a pediatrician, says there are short and long term risks of not breastfeeding to both the infants and nursing mothers.

Infections
Failure to breastfeed significantly increases an infant’s risk of illness from infectious diseases such as diarrhoea, middle ear infections (acute otitis media), and lower respiratory tract infections (including pneumonia).
“There is also increased risk of hospitalisation and mortality among the infants who are not breastfed.”

Infant death syndrome
Failure to breastfed increases an infant’s chance of dying from sudden infant death syndrome (SIDS).

A recent research study shows that babies who were breastfed were approximately 60 per cent less likely to die from SIDS than unbreastfed babies. The protective effect of breastfeeding increases with increased breastfeeding.

Weight
Infants who are not breastfed but fed on formula milk have increased risk of being overweight and obese. “These conditions have associated complications such as diabetes and hypertension which are on the rise lately.”

Allergies
Babies that are not breastfed are highly susceptible to allergies such as skin allergies (atopic dermatitis) and asthma. “Exclusive breastfeeding of an infant for at least four months will help their bodies fight off asthma, eczema as well as food allergies,” says Dr Ssegujja.

Childhood cancers
Infants who are not breastfed but rather given formula milk are susceptible to cancer such as leukemia and lymphoma. It is also associated with poorer scores on development and cognitive screening tools. “Breastfed infant have higher IQs and tend to do well in school.”

Effects on nursing mothers
Dr Ssegujja says maternal health outcomes of failure to breastfeed include increased risk of breast cancer, ovarian cancer, cardiovascular disease, diabetes and hypertension, reduced maternal bone health (osteoporosis), increased sleep disturbances, postpartum depression and decreased postpartum weight loss.”

Supplement
After six months, breastmilk is supplemented with other solid food to match the feeding needs of the baby. However, Dr Ssegujja says cow milk is not recommended until a baby makes one year. “Formula milk is safer for supplementation.”

While exclusive breastfeeding for the first six months is the recommendation, the case is different for working mothers.

“Currently, most organisations only offer maternity leave that often lasts 60 days. This duration is shorter than the six months recommended for exclusive breastfeeding, hence forcing most mothers to start supplementary feeding too early,” Dr Ssegujja says.

Nursing homes at work
He says most work places do not provide space for breastfeeding mothers, leaving them with no option but to leave their children at home.

“There is need to advocate for longer paid maternity leave. Organisations should also establish nursery and baby play area for breastfeeding mothers at their workplaces to support nursing mothers,” he says.

Breastfeeding vs work
This is one of the downsides of motherhood for every corporate woman. Dr Lorraine Oriokot, a mother and pediatrician, says that while the experience was challenging, it was worth it.

“After three months of maternity leave, I had to return to work. Although it was shortlived, I chose to add my annual leave to make four months, so I could focus on the baby and breastfeeding for that period. While this worked out for my first two children, it was not possible for the third since I had changed jobs,” she says.

Expressing milk
Dr Oriokot had prior experience with expressing milk and this helped her cope with less difficulty. Her plan has been to build a breast milk bank because frozen breast milk can last a year or more. However, this did not work because the baby had a very high appetite so she hardly had any to freeze.

As such, she resorted to expressing daily and refrigerating or freezing depending on how much she had stored. She says she researched on breast milk storage and expressing, which you don’t usually learn in antenatal care or even after delivery.
According to Oriokot, breastmilk can last six hours at room temperature and 24 hours in a refrigerater, which helps in planning for storage. But it was challenging to express milk at work because of a shared office space and not many offices have the luxury of fridges.

Hygiene is key
Dr Oriokot says expressing breastmilk requires hygiene and a separate bag for the breast milk expressing supplies. While some women can afford breast pumps, others can express breastmilk manually, especially when the breastmilk production is high or when the breasts were engorged.

Although many mothers assume that expressing is inadequate for the baby, Dr Oriokot swears by it.

“It requires a lot of patience. Be kind enough to yourself when you don’t have enough milk,” Dr Oriokot says.

Nakirya says expressing milk was painful in the first months and formula was too expensive to afford. However, Dr Oriokot says the process should not be painful.

“If you find it painful, there is a problem with the technique and you will need help. Usually after birth, there may be a small volume of milk produced or none at all. As you continue to place the baby on the breast, the supply builds up and within 24 to 48 hours, there should be sufficient milk,” she says.

What causes low supply
The supply of breastmilk can also be affected by several factors such as stress and pain. That said, most mothers are able to establish breast feeding with a little support.

However, many corporate women will give up owing to the pressure of meeting deadlines. But Dr Oriokot says the journey is different for every nursing mother.

Expressing vs formula
The thought of expressing milk may conjure expenses in many mothers’ minds but Nakirya says apart from buying a pump at Shs20,000, it is cheap compared to buying formula milk.

On the market, there are manual and electric pumps. An Avent electric pump costs about Shs200,000 but one needs to use the minimal power button because every button gives you varying pressure power (how hard the nipple is sucked by the pump) and the higher, I discovered, the more painful.

Dr Oriokot says working mothers can afford to express breast milk. “Manual expression is cheap and does not require any additional equipment. When picking what to use, ensure the technique and positioning are done well so you do not feel uncomfortable,” she says.